The question of competency to consent to sexual activity in the cognitively impaired population continues to be a difficult assessment issue. Problems center on inconsistent legal and clinical criteria, current inadequate methods of psychological assessment, and the need to promote basic human rights, while protecting people from harm. The purpose of this study was twofold. First, the problems inherent in the psychological assessment of competency to consent to sexual activity are discussed with an emphasis on problems defining consent competency. Second, the utility of a neuropsychological test battery in assisting with the assessment of the ability to consent to sexual activity was examined. Findings indicated that executive measures of neuropsychological assessment were primarily associated with competency to consent to sexual activity. It is important that these neuropsychological measures were more accurate in categorizing competent and noncompetent individuals than methods currently in use. This suggests that sexual consent assessments in the forensic arena should include neuropsychological testing and that current methods are insufficient. (PsycINFO Database Record (c) 2004 APA, all rights reserved)